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Branstad keeps focus on IowaCare, not Medicaid

March 4, 2013

DES MOINES (AP) — Gov. Terry Branstad is expected to soon reveal his plans for revamping the IowaCare health program for low-income adults, sticking to an approach he holds is better for the state than the Medicaid expansion Democrats are clamoring for.

Without details, it’s hard to know if a beefed-up IowaCare would solve Linda Cunningham’s problems. The 58-year-old, who complains of fatigue and chest pain, said she can’t afford the bus ride from her Council Bluffs home to Broadlawns Medical Center in Des Moines, one of just two locations where IowaCare patients can get hospital treatment.

“I feel like I can’t get the medical treatment that I need. I don’t have the resources to go there,” said Cunningham, whose church helped her get the money for a bus ticket to Des Moines last year.

Enacted in 2005 under then-Gov. Tom Vilsack, IowaCare was designed to provide limited health benefits to low-income adults who don’t qualify for Medicaid. The program covers single adults and childless couples with incomes up to 200 percent of the federal poverty line — or $22,340 annually for a single person.

When it debuted, IowaCare was hailed for providing a safety net to some of the state’s most vulnerable. But the program — which now has about 70,000 enrollees — offers very minimal coverage, with hospital care in only Des Moines and Iowa City, no mental health treatment and no prescription drug benefits. Transportation to appointments is not provided.

Still, Branstad holds that improving IowaCare is better than accepting federal funding to expand Medicaid to cover more low-income adults, a key part of the Obama administration’s health care overhaul, geared at reducing the number of uninsured. There are about 300,000 people in Iowa without health coverage, according to state officials. Families who don’t qualify for Medicaid can get low or no-cost coverage for their children through the Hawk-I program.

Medicaid currently covers over 400,000 financially needy children, families and disabled people in Iowa. They have a wide range of public and private doctors they can visit and get prescription coverage and mental health care, unlike the IowaCare enrollees. Under the expansion plan, the Medicaid eligibility limit would be raised to 138 percent of the federal poverty level, or about $15,400 annually for an individual.

If Branstad agreed to expand Medicaid, the federal government would pay the full cost for the new enrollees for the first three years, then 10 percent of the cost would gradually be shifted to the state. An estimated 150,000 people would be added to the state’s Medicaid rolls, including more of those currently on IowaCare. IowaCare gets a much lower federal reimbursement rate.

But Branstad said he’s not convinced the federal government will keep its promise.

“My concern is buying into an expansion that’s unaffordable and unsustainable,” Branstad said. “I think with the federal financial mess, it’s just a matter of time, they’re just going to come in and cut these entitlements.”

Branstad met with U.S. Health and Human Services Secretary Kathleen Sebelius last month to convey his plans for Iowa. Information he provided to Sebelius shows he’d like a revised IowaCare to include preventative health measures and ways for patients to better manage care in a holistic way. Branstad said he wanted to encourage healthy behavior.

“I want to partner with people and say, if you’re willing to do some things, the state is going to do some things,” Branstad said.

To date, eight Republican governors have said they’ll accept funding for a Medicaid expansion, including those in Ohio, New Jersey and Florida. Iowa Democrats are applying heavy pressure to Branstad and have passed Medicaid expansion legislation through a Senate committee. They argue that more people would get better coverage under an expansion.

“We are not going to adjourn until we solve this problem,” said Sen. Jack Hatch, D-Des Moines, a vocal advocate of the expansion. He noted that any revised version of IowaCare would require legislative approval.

While speculation continues in the Capitol about whether Branstad could change course, as some other governors have done, University of Iowa professor Keith Mueller said Branstad’s stance seems difficult to reverse.

“For Iowa, if you take what the governor is saying at face value, he’s saying he’s reluctant to commit the state to bringing a very large cohort of people into the Medicaid program, based on a promise or a note from the federal government. If you’ve take that position, there’s really nothing you would do, other than what he is doing,” said Mueller, who is head of the university’s department of health management and policy.

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